While rates of scurvy are nowhere near as high as they once were, the vitamin C deficiency best known for plaguing sailors during long voyages is still around. When cases do emerge, they can offer physicians clues as to why the easily treated condition still occurs. New research from a case study in Australia points to the cost of living crisis’ impact on nutrition and the rise of weight loss surgeries as a potential driver of scurvy cases. The findings are described on October 22 in the journal BMJ Case Reports.
What is scurvy?
Scurvy is caused by a severe lack of vitamin C, also called ascorbic acid. According to the Cleveland Clinic, vitamin C is a very key nutrient for the human body. It helps the development, growth, and healing of the skin, bones, and connective tissue. Vitamin C is also needed for the blood vessels to function properly, it helps maintain our teeth and gums, helps the body absorb the iron it requires to make red blood cells, and helps heal burns and other wounds.
[Related: It took centuries (and vitamins) for doctors to finally stop scurvy.]
As an antioxidant, vitamin C also helps protect our cells against damage from free radicals–byproducts of normal cell activity which participate in chemical reactions within cells. Over time, some of those chemical reactions can cause damage. If someone does not get enough vitamin C in their diet for about two to three months, it can lead to scurvy in extreme cases.
Symptoms of scurvy include general weakness, anemia, gum disease, poor wound healing, and skin hemorrhages. In the United States, scurvy most commonly affects babies, children, and older adults who don’t get enough vitamin C from their diets.
Cost of living’s impact on diet
In the new case study, the authors treated a middle aged man in Australia. His legs were covered with small painful red-brown pinpoints that looked like a rash. Blood was also present in his urine and he was anemic.
The patient tested negative for inflammatory, autoimmune, and blood disorders and there was no evidence of internal bleeding based on body scans or other diagnostic clues from skin biopsy. The rash also continued to spread while in the hospital.
The patient revealed that he was struggling financially and often neglected his diet, eating few fruits and vegetables and sometimes skipping meals. He also stopped taking the nutritional supplements that were prescribed for him after previous weight loss surgery, due to the costs.
The blood tests indicated no detectable levels of vitamin C and extremely low levels of other key nutrients. The authors diagnosed him with scurvy and treated him with daily vitamin C (1000 mg), vitamin D3, folic acid, and multivitamin supplements. This rash and other symptoms cleared up with this treatment.
According to the authors, this is one case report and the disease is relatively rare, but should be monitored. The rising cost of living has also made it more difficult for families to afford nutritious food.
“Scurvy is still seen as a disease of the past, especially in developed countries,” the authors wrote in a statement. “Our patient had multiple risk factors, namely, poor dietary habits, obesity, previous bariatric surgery, use of proton pump inhibitors and low-income status. His history of iron, vitamin D and folate deficiencies were also clues to his underlying nutritional deficiency.”
Is scurvy on the rise?
Rates of vitamin C deficiency vary from country to country. In the US, about 7.1 percent of people may develop a deficiency, while in north India, the rate is 73.9 percent. However, there are still some isolated reports like the one in the UK. A case report published in the Canadian Medical Association Journal in early October detailed scurvy in a 65-year-old woman who mostly lived on a diet of canned soup and fish and no fresh produce. Her ability to shop for groceries, cook, and perform other daily activities were limited by mobility issues and she received very little in the way of outside support with these tasks.
“This case presents a complex example of food insecurity manifesting as an uncommon diagnosis,” Dr. Sarah Engelhart, a study co-author and general internist at Mount Sinai Hospital and the University of Toronto, said in a statement. “A unifying diagnosis was uncovered only after a detailed assessment of her social and dietary history.”
[Related: Do you need a daily multivitamin? Probably not, says national health task force.]
There are also some signs that scurvy might be on the rise. A review published in July in the journal JAAOS: Global Research and Reviews also found that between 2016 and 2020, pediatric incidences of scurvy more than tripled from 8.2 to 26.7 cases per 100,000 cases in children. Many of the patients also had autism spectrum disorder, which can cause sensory issues that can lead to avoidance of certain nutritious food groups. Being in a lower economic class was also a risk factor, according to this report.
While it is still generally rare for the general population and not something to stress about, it is still something for clinicians and patients to be vigilant for as costs rise.
Prevention and treatment
Eating enough vitamin C is the best way to prevent scurvy. Most healthy adults should get about 75 to 90 milligrams a day. Adding fresh fruits and vegetables to every meal is the most effective way to increase vitamin C intake, so it is important to eat a variety of nutritious foods. Clinicians are also being advised to monitor this in relation to increasing incidence of food insecurity.
Fortunately, the disease is fairly easy to treat. Vitamin C supplements under a physician’s supervision and more produce intake are often the first course of treatment and some report feeling better within the first 48 hours of the increased vitamin intake.
